Yellow Fever Outbreak in the Amazon

Group 9

Emergency Operation Center (EOC)

Following suspected cases/deaths

Planning / Analysis / Logistics / Communications

  • Other stakeholders

    • Mayor

    • Health secretary

    • Health Care professionals

Yellow Fever: An overview

Yellow fever outbreak in Brazil: the puzzle of rapid viral spread and challenges for immunisation. Possas C, et al. (2018).

Municipality X

  • 100.000 inhabitants
  • 70% vaccinated
  • Endemic for yellow fever
  • Mining + deforestation
  • Situation
    • 1 death of YF
    • 2 suspected cases
    • Rumors of 3 dead primates

Approaching the situation

1) PRIORITY: Outbreak confirmation

  • Lab confirmation of human and non-human
  • Investigate travel history
  • Contact-tracing
  • Gather clinical-epidemiological info
  • For negative cases: metagenomic analysis

2) OUTBREAK CONTROL:

  • Alert local government and health system
  • Assess vaccination
  • Promote vaccination campaign
  • Active search of cases
  • Environmental surveillance for
    • Mosquitoes investigation
    • Control transmission in Primates
    • Is the cycle urban?

3) NEXT STEPS:

  • For negative cases perform metagenomic analysis
  • To be continued …

Approaching the situation 2

1) Outbreak confirmation

  • Lab confirmation for human and primate cases
  • Investigate travel history
  • Contact-tracing
  • Clinical-epidemiological info

2) CONTROL

  • Alert government/health system
  • Assess and promote vaccination status
  • Active search
  • Environmental surveillance for
    • Mosquitoes / Primates
    • Urban cycle?

3) NEXT STEPS

  • For negative cases perform metagenomic analysis
  • To be continued …

Epidemic progression

Spatial distribution

  • The cases were concentrated in region 8, 9, and 10.
  • We hypothesize that these regions are closest to mining area and the forest
  • Risk of spread to other areas in the city

Symptoms

Plan of Action

PREVENTION

Vaccinations

  • Request more vaccines.
  • Logistics: campaigning, accessibility.
  • If limited resources:prioritize higher incidence and mortality population.

Vector control

  • Space spray
  • Mosquito surveillance in the households
  • Mosquito repellents
  • Bed nets

RESPONSE

Health-care

  • Primary care and Hospital
  • Fluids, medicines and Beds
  • Human resources
  • Health education

Labs

  • Diagnosis

Secondary Response

  • Social and Economical Support

Communications

  • Strategies for defined target groups:

    • Authorities
    • General public
    • Health workers
    • Schools
    • Community health agents

  • Daily situation report and weekly meetings

New chalenges

Most mining workers are undocumented immigrants

Rumours that mining workers are killing monkeys.

Mayor and population pressure authorities to allow hunting of wild animal.

Drug cartel is partially controlling the mining area hindering access

Adapting to the new challenges

Approaching the miners

Adapting to the new challenges

Approaching general population

Adapting to the new challenges

Approaching authorities

Addressing resource limitations

Investigate causes of increased mortality

Address vaccine hesitancy

Guarantee vaccination & hospital beds

Enhance prevention measures

Improve monitoring & data collection

Propose future research

Lessons learned

  • We need collective efforts from multidisciplinary backgrounds

  • Define priorities and secondary steps

  • Focus on hypotheses and plans that can give us quick answers

  • Communicate and engage with stakeholders and population

  • Think outside the box

  • Make the most out of the information we have rather than focusing on what we don’t have

  • Capitalize on our strengths and our partnerships

  • Public health is political

  • Life can always get harder

Thank you!